title: Telehealth system (e-CUIDATE) to improve quality of life in breast cancer survivors: rationale and study protocol for a randomized clinical trial.
abstract: BACKGROUND
  Breast cancer survivors suffer physical impairment after oncology treatment. This impairment reduces quality of life (QoL) and increase the prevalence of handicaps associated to unhealthy lifestyle (for example, decreased aerobic capacity and strength, weight gain, and fatigue). Recent work has shown that exercise adapted to individual characteristics of patients is related to improved overall and disease-free survival. Nowadays, technological support using telerehabilitation systems is a promising strategy with great advantage of a quick and efficient contact with the health professional. It is not known the role of telerehabilitation through therapeutic exercise as a support tool to implement an active lifestyle which has been shown as an effective resource to improve fitness and reduce musculoskeletal disorders of these women.
  
  
  METHODS
  This study will use a two-arm, assessor blinded, parallel randomized controlled trial design. People will be eligible if: their diagnosis is of stages I, II, or IIIA breast cancer; they are without chronic disease or orthopedic issues that would interfere with ability to participate in a physical activity program; they had access to the Internet and basic knowledge of computer use or living with a relative who has this knowledge; they had completed adjuvant therapy except for hormone therapy and not have a history of cancer recurrence; and they have an interest in improving lifestyle. Participants will be randomized into e-CUIDATE or usual care groups. E-CUIDATE give participants access to a range of contents: planning exercise arranged in series with breathing exercises, mobility, strength, and stretching. All of these exercises will be assigned to women in the telerehabilitation group according to perceived needs. The control group will be asked to maintain their usual routine. Study endpoints will be assessed after 8 weeks (immediate effects) and after 6 months. The primary outcome will be QoL measured by The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 version 3.0 and breast module called The European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life questionnaire. The secondary outcomes: pain (algometry, Visual Analogue Scale, Brief Pain Inventory short form); body composition; physical measurement (abdominal test, handgrip strength, back muscle strength, and multiple sit-to-stand test); cardiorespiratory fitness (International Fitness Scale, 6-minute walk test, International Physical Activity Questionnaire-Short Form); fatigue (Piper Fatigue Scale and Borg Fatigue Scale); anxiety and depression (Hospital Anxiety and Depression Scale); cognitive function (Trail Making Test and Auditory Consonant Trigram); accelerometry; lymphedema; and anthropometric perimeters.
  
  
  CONCLUSIONS
  This study investigates the feasibility and effectiveness of a telerehabilitation system during adjuvant treatment of patients with breast cancer. If this treatment option is effective, telehealth systems could offer a choice of supportive care to cancer patients during the survivorship phase.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT01801527.
authors.affiliation: Department Physical Therapy, University of Granada, Granada, Spain. noeliagaliano@ugr.es
authors.forename: Noelia
authors.initials: N
authors.lastname: Galiano-Castillo
authors.forename: Angelica
authors.initials: A
authors.lastname: Ariza-García
authors.forename: Irene
authors.initials: I
authors.lastname: Cantarero-Villanueva
authors.forename: Carolina
authors.initials: C
authors.lastname: Fernández-Lao
authors.forename: Lourdes
authors.initials: L
authors.lastname: Díaz-Rodríguez
authors.forename: Marta
authors.initials: M
authors.lastname: Legerén-Alvarez
authors.forename: Carmen
authors.initials: C
authors.lastname: Sánchez-Salado
authors.forename: Rosario
authors.initials: R
authors.lastname: Del-Moral-Avila
authors.forename: Manuel
authors.initials: M
authors.lastname: Arroyo-Morales
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D002985:Clinical Protocols; D005080:Exercise Test; D005081:Exercise Therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020407:Internet; D009367:Neoplasm Staging; D010147:Pain Measurement; D010808:Physical Examination; D010809:Physical Fitness; D011237:Predictive Value of Tests; D011788:Quality of Life; D012107:Research Design; D040242:Risk Reduction Behavior; D013030:Spain; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D017216:Telemedicine / Q000379:methods*; D013813:Therapy, Computer-Assisted; D013997:Time Factors; D016896:Treatment Outcome